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What should oncologists tell their patients who are interested in complementary and alternative medicine?
Michael Fisch, MD, MPH
Have an honest discussion about alternative therapies
It’s worth being mindful that you maintain the same patient-centered stance that you do for all your interactions with patients; that you avoid actions or words that seem rooted in arrogance or defensiveness. Try not to let yourself be reactive to the whole realm of complementary and alternative medicine any more than you would be to chemotherapy. There’s no point in that.
I find it useful to distinguish between “unproven” therapies and “disproven” therapies. There are some patients who mention therapies that have been researched and flat out don’t work, or they have unwanted effects and they ought to be avoided. Knowing that there is existing research and speaking openly about disproven therapies is fine. There are some unproven things or unexplored approaches one might want to look into it before commenting.
I often find it appropriate to acknowledge that there are other theories of health and disease that I’m not expert in that are based on an entirely different paradigm. I’m trained in allopathic medicine, and there is a very specific way of thinking and training that goes with that. Whatever the situation, there is no point in just waving your hands and saying, “That isn’t what I do.” Blanket condemnations don’t come across as open-minded or patient-centered.
Most importantly, it is worth seeing this topic as an opportunity to understand your patient more completely and thus find more opportunities to provide the very best care. If patients are bringing up a subject, there is something behind that. Either they want to know how you think or they’re trying to tell you something about themselves. For example, if a patient asks, “What do you think about acupuncture for dealing with a dry mouth?” you may find it useful to explore that further. The real issue may be related to the expense or inconvenience of other medications, frustrations about poor access to care or some other topic that is not fundamentally related to complementary/alternative therapies.
Michael Fisch, MD, MPH, is Chair of the Department of General Oncology at The University of Texas M.D. Anderson Cancer Center.
Wallace Sampson, MD
Tell them that none are effective
They should be telling them that none of it works. That’s already been proven for just about every one of these therapies, and the ones that haven’t been disproven to our satisfaction are so highly implausible they shouldn’t even be researched.
CAM practitioners make it up. They invent it. This isn’t medicine that comes down through a tradition of having worked. It comes from a tradition of observing incorrectly and drawing incorrect conclusions based on misperception.
You have fraud, you have traditional approaches from various cultures and you have ideological approaches. The latter two are not frauds, they’re simply erroneous. They’re also implausible, and most of them have already been shown not to work.
To me, it is not as important to define what one would tell a patient because each situation calls for a specific approach and wording. What is more important is for reporters and physicians to know the background of the present situation.
We’ve been teaching that these are fraudulent, disproved and implausible claims for 30 or 40 years, at least my generation has, and the movement toward acceptance of sectarian systems and disproved and implausible claims by influential members of important social institutions occurred while no one ever asked us about it. The few who did ask disregarded what we had to say, including the Federation of State Medical Boards and the National Academy of Sciences. They know what we say. They don’t want to hear it because the money from the supplement industry and large granting agencies are supporting medical school departments. The economic situation is such that if they hear us, they won’t do anything about it.
Wallace Sampson, MD, is an Emeritus Clinical Professor of Medicine at Stanford University.